State Rules Force Office-Based Surgeon Into Hospital ORs

Ophthalmologist Lee Birchansky, MD, has been practicing in Cedar Rapids, Iowa, for 21 years, but he's no longer permitted to perform cataract surgeries in his office at the Fox Eye Laser & Cosmetic Institute.

State health officials see his office-based setting as inadequate for the procedure, have rejected his repeated requests to certify it as a surgical facility and, most recently, have denied a re-hearing on his request to continue conducting the surgeries there.

The move has forced his administrative staff to reschedule cataract patients into the ORs at area hospitals, even as he continues to see laser surgery patients in office.

Dr. Birchansky's practice is no back-room operation - it has marketed itself on a local billboard - but the Iowa Department of Public Health sees it as an uncertified surgical center and has ordered it to stop providing cataract surgeries, fining it $20,000 in the process.

At a recent appeal, state officials argued that the surgery required a sterile environment, which inspections had shown the office-based setting was not, and that cataract surgery was not often performed outside of surgical ORs. Dr. Birchansky replied that laser surgery, blepharoplasty, vasectomy and even cosmetic procedures were allowed in office settings.

He has applied for a certificate of need to perform cataract cases on 4 occasions. The Iowa Health Facilities Council has denied his applications each time, a move supported by nearby St. Luke's Hospital and Mercy Medical Center.

While the stated reasons for the rejections were to prevent surgical services redundancy, overcapacity and overspending, Dr. Birchansky says he questions whether the certificate of need system isn't just creating a monopoly for the region's large players.